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0000 PARADISE AVENUE - Street Files
rn J p inment retains -original appncation ana Issues aupucaie as r-nrmlt. $90/7)Wn/0/17, o/Q/ 1 ) 19 APPLICATION and PERMIT I Fee: /D(�'� for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L..Chapter 148, Section 38A, 527 CMR. 9.00, application is hereby made by: ok(i -tX St(}6i Solr X 711•1.1- S 1, --J3-11 Q� U wi ?C 77 0 :owner::` Tank Owner Name i Address .1 / emova';,:• • R'rac or Company Namrs,vO i r...101 �- Address 1:1 Vi eld) &\ tM Sfii 4Ve@et d' 1, Signature (if applying for pe IFCI CeNf!e Tank Location t Tank Capacity (gallons) it) . CraCI ei rot Gtre Gui,w Sleet Maras: V state rtintrfrasEtilligptii Co. or Individual. Address Signature (if applying for permit) 0 IFCI Certified 0 LSP # r chi / Substance Last Stored d F' ` ©° Tank Dimensions (diameter x length) S� (� Remarks: Ut'i -° q7D -7414— g3 - •/ !b fry TatitA 110 Other r f2e/yvo,tPd :Daspasalln:orani ti► n Firm transporting was!'S \• •.II yVl YU )IKC State Laic 7t 3 / a aU Hazardous waste manifest • I O.O Q QO ,C.1 R. 9 C T N E.P.A. # Approved tank'dispoosal yard Type of inert gas. Cal- . pro. City or Town ' Date,of issue r t.N i61i61,lo SeitPnf /2/r�i) IDig safe approval number. Tank yard address Mr ac oosa z r) lv.S _Tank yard # # .• ?rb to L(3) Smolt 173 very , 1/1,2t9 Signature 1 Title of Officer granting permit/.P.r.. Z'z.,Gr rLL z After removal(s) send Form FPr290R signed by Local Are Dept, to UST Regulatory Compliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108-1618, FDID:. (') 9a?5-7 Permmit# Date of expiration //1t�/O Dig Safe Toll.Free Tel. Number - 800-3'22-4844 I 1 :?.292 (revised 9196)